Healthcare Provider Details

I. General information

NPI: 1073430484
Provider Name (Legal Business Name): ELINA NIYAZOV OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TUDOR CITY PL
NEW YORK NY
10017-6853
US

IV. Provider business mailing address

40 SUNSET RD S
ALBERTSON NY
11507-1149
US

V. Phone/Fax

Practice location:
  • Phone: 917-924-2651
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ELINA NIYAZOV
Title or Position: OWNER
Credential: OD
Phone: 347-564-4479